Provider Management Sample Clauses

Provider Management. The Provider Management business area is a collection of business processes that focus on recruiting potential providers, supporting the needs of the population, maintaining information on the provider, and communicating with the provider community. The goal of this business area is to maintain a robust provider network that meets the needs of both beneficiaries and provider communities and allows the Commonwealth Medicaid agency to monitor and reward provider performance and improve healthcare outcomes. The Commonwealth provides most of its Medicaid services through MCOs. The Provider business processes serve as the control point and central source of information on all providers and provider applicants. Files are maintained that provide comprehensive information on each provider, billing agency, trading partner, and provider group participating in the Commonwealth programs. MEMS solution shall provide access to all Provider Management functionality related to all Medicaid Providers and Provider Organizations through Commonwealth’s self service Provider Portal. Commonwealth’s self service provider portal, under development using Microsoft .net technology, will provide functionality related to enrollments and eligibility enquiries. The transition between the MEMS solution and Commonwealth’s Self Service portal should be transparent and seamless to the end users with no additional logins. The MEMS solution shall be responsible for including but not limited to:
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Provider Management. The Users with the role of Provider Organisation Administrator can perform the following activities for the management of their organisation: Edit organisation details View the users registered within the Provider organisation Edit the UNSPSC codes registered for the Provider Add new users to the Provider organisation Edit user’s details Export Auditing Reports This management functionality is provided through the “Provider Management” option of the “Provider Administration” menu. Figure 21: Provider menu Figure 22: Provider Management functionality
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Provider Management. Contractor shall capture, manage, and maintain information for the State’s prospective or enrolled health care Providers (“Providers”) and support Provider eligibility determination and enrollment business processes. Contractor shall support communications between the State and the prospective or enrolled Providers. Communication management functions include functions such as: Provider correspondence and notifications, outreach and education, enrollment and revalidation, and Provider appeal management and tracking within the Provider Management Module (PMM) system. Contractor shall maintain PMM Software as a Service (SaaS) solution consisting of multiple modules hosted in a cloud platform. The system serves the Vermont Provider community and the State by enabling the following: Provider Enrollment, Provider Screening and Workflow, Provider Portal for data maintenance, and Provider Management for internal user access to Provider records. PMM Release Management Contractor shall make PMM periodic SaaS releases and software updates available to the State. Contractor shall coordinate with the State on periodic release projects to ensure the State remains on a supported version of the solution. Contractor shall publish software documentation specific to each PMM release including release schedules, release notes, and software documentation. Each release of PMM functionality shall follow testing best practices and key test levels to include System Integration Testing and User Acceptance Testing, and standardized defect management processes. Contractor shall provide services and applications to support Provider Management, including but not limited to the following impacted MITA Business Processes:
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Provider Management. The Contractor shall assign responsibility and establish procedures to monitor, manage and continuously improve the performance of its provider network. These procedures shall ensure that:
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Provider Management. Current MCOs shall maintain effective communications with its providers.
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Related to Provider Management

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity

  • Member Management Except as otherwise expressly provided in this Agreement, the business and affairs of the LLC shall be managed and controlled by the Member, and the Member shall have full, exclusive and complete authority and discretion to make all the decisions affecting the business and affairs of the LLC, and to take all such actions as the Member deems necessary or appropriate to accomplish the purposes of the LLC; and any actions taken by the Member shall be binding on the LLC.

  • Virus Management Transfer Agent shall maintain a malware protection program designed to deter malware infections, detect the presence of malware within the Transfer Agent environment.

  • Project Management Project Management Institute (PMI) certified project manager executing any or all of the following: • Development of Project Charter • Development of project plan and schedule • Coordination and scheduling of project activities across customer and functional areas • Consultation on operational and infrastructure requirements, standards and configurations • Facilitate project status meetings • Timely project status reporting • Address project issues with functional areas and management • Escalation of significant issues to customers and executive management • Manage project scope and deliverable requirements • Document changes to project scope and schedule • Facilitate and document project closeout

  • Collaboration Management Promptly after the Effective Date, each Party will appoint a person who will oversee day-to-day contact between the Parties for all matters related to the management of the Collaboration Activities in between meetings of the JSC and will have such other responsibilities as the Parties may agree in writing after the Effective Date. One person will be designated by Merck (the “Merck Program Director”) and one person will be designated by Moderna (the “Moderna Program Director,”) together will be the “Program Directors”. Each Party may replace its Program Director at any time by notice in writing to the other Party. Any Program Director may designate a substitute to temporarily perform the functions of that Program Director by written notice to the other Party. The initial Program Directors will be: For Moderna: [***] For Merck: [***]

  • Management (a) The General Partner shall conduct, direct and manage all activities of the Partnership. Except as otherwise expressly provided in this Agreement, all management powers over the business and affairs of the Partnership shall be exclusively vested in the General Partner, and no Limited Partner shall have any management power over the business and affairs of the Partnership. In addition to the powers now or hereafter granted a general partner of a limited partnership under applicable law or that are granted to the General Partner under any other provision of this Agreement, the General Partner, subject to Section 7.3, shall have full power and authority to do all things and on such terms as it determines to be necessary or appropriate to conduct the business of the Partnership, to exercise all powers set forth in Section 2.5 and to effectuate the purposes set forth in Section 2.4, including the following:

  • Contract Management To ensure full performance of the Contract and compliance with applicable law, the System Agency may take actions including:

  • Change Management BellSouth provides a collaborative process for change management of the electronic interfaces through the Change Control Process (CCP). Guidelines for this process are set forth in the CCP document as amended from time to time during this Agreement. The CCP document may be accessed via the Internet at xxxx://xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx.

  • Providers Services performed by a provider who has been excluded or debarred from participation in federal programs, such as Medicare and Medicaid. To determine whether a provider has been excluded from a federal program, visit the U.S. Department of Human Services Office of Inspector General website (xxxxx://xxxxxxxxxx.xxx.xxx.xxx/) or the Excluded Parties List System website maintained by the U.S. General Services Administration (xxxxx://xxx.xxx.gov/). • Services provided by facilities, dentists, physicians, surgeons, or other providers who are not legally qualified or licensed, according to relevant sections of Rhode Island Law or other governing bodies, or who have not met our credentialing requirements. • Services provided by a non-network provider, unless listed as covered in the Summary of Medical Benefits. • Services provided by naturopaths, homeopaths, or Christian Science practitioners.

  • Program Managers See Section 14.1.

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